Eurohealth Vol 17 No 2–33

The share of the population aged 80 years and over is expected to more than double in coming decades across the OECD, growing from 4 % in 2010 to close to 10% by 2050 (Figure 1). Although the speed at which populations are ageing varies con-siderably across countries, and despite uncertainties about future trends in dis-ability among the older population,1 these demographic transformations are expected to significantly increase demand for long-term care (LTC) services. Meanwhile, declining family size, changes in residential patterns of people with disabilities and the rising female participation in the formal labour market will contribute to a decline in the availability of family carers, leading to an increase in the need for paid care. These transformations will put upward pressure on total expenditure of formal long-term care systems, and this will occur concurrently with the growth of other major age-related expenditures, such as public pensions and health services, with the potential risk of shifting costs to future generations. This means that the way expenditures and revenues are set, particu-larly in the area of LTC, needs to be more forward looking. After outlining LTC cost projection scenarios, this article provides policy recommendations on how to provide fair LTC protection, whilst ensuring that this protection is fiscally sus-tainable in the long run. In doing so it draws on findings of a major report pre-pared by the OECD.2 Sizing the challenge ahead: projected LTC costs On average OECD countries allocate 1.5 % of their Gross Domestic Product (GDP) to LTC. Some countries spend more than 2 % of their GDP (for example